The Hunters Point Naval Shipyard in San Francisco is being redeveloped into housing and commercial space. Between 1946 and 1969, however, the former Navy shipyard was involved in activities that created significant amounts of radioactive waste. First, the facility was the location of top-secret nuclear tests. Second, it was where ships were decontaminated after returning from hydrogen bomb tests. Cleaning up the radioactive waste is expected to cost at least $1 billion.
Between Jan. 1, 2006 and Dec. 31, 2011, the Justice Department says, a Miami-based mortgage originator called the Universal American Mortgage Company LLC (UAMC) knowingly originated mortgages under the Federal Housing Administration mortgage insurance program that did not qualify with that program's lending requirements. These defective loans violated the False Claims Act because the FHA mortgage insurance program is left on the hook when its insured mortgages go into foreclosure.
When someone blows the whistle on fraud, waste or abuse in federal programs, they can often receive as a reward a substantial portion of any money recovered on behalf of the government. This is called the qui tam provision of the federal False Claims Act. In a recent pair of consolidated False Claims Act cases, the whistleblower will receive a reward of $5,411,521.
Medicare Advantage plans are owned and operated by private organizations called Medicare Advantage Organizations (MAOs). Medicare beneficiaries can enroll in and obtain healthcare through these plans. Unlike in traditional Medicare, MAOs are not paid based on services rendered but instead receive a fixed monthly amount for each beneficiary's care. Since some patients require more care than average, payments from Medicare to MAOs are "risk adjusted" to reflect the beneficiary's health status. In other words, MAOs receive higher payments for patients whose conditions require more care.
The federal government intervened in eight False Claims Act lawsuits and brought criminal charges against Health Management Associates, LLC (HMA), a hospital chain that has since been sold. According to the Justice Department, HMA engaged in a scheme to defraud the U.S. The allegations include:
It was an interesting scheme. According to allegations by the Department of Justice, Reliant Rehabilitation Holdings, Inc., wanted to induce or reward its client nursing homes for referring patients to Reliant for rehabilitation therapy. So, it sent over nurse practitioners employed by Reliant to work for those nursing homes for free or below market value.
It has been reported that Post Acute Medical, LLC, and certain affiliates ("PAM") have agreed to pay $13,168,000 to settle claims by the Justice Department, Texas and Louisiana that they violated the False Claims Act and parallel state statutes. The nationwide operator of rehabilitation and long-term care hospitals was accused of knowingly submitting claims to Medicare and Medicaid that were the result of violations of the Physician Self-Referral Law and the Anti-Kickback Statute.
Earlier this summer, the Securities and Exchange Commission issued a proposal that would give it greater discretion when making awards to people who blow the whistle on securities violations under the Dodd-Frank Act. Allowing it to offer larger awards in small cases would foster compliance in the industry, the agency says. It would pay for the increases by cutting into the very large awards paid out in a handful of cases each year.
Pharmaceutical manufacturer Insys Therapeutics, Inc., has tentatively agreed to settle allegations by the U.S. Justice Department that it paid kickbacks to doctors in order to get them to prescribe its drug Subsys. The drug is an under-the-tongue spray containing the opioid fentanyl, which is some 100 times stronger than morphine. Subsys was intended to manage pain in cancer patients.
Calling it a "transformative year" for its whistleblower program, the Commodity Futures Trading Commission (CFTC) announced recently that it has awarded whistleblowers more than $45 million in rewards for identifying illegal activity. This is a dramatic increase over prior years.